POS0812 CAROTID INTIMA-MEDIA THICKNESS/DIAMETER RATIO AND PEAK SYSTOLIC VELOCITY AS RISK FACTORS FOR NEUROLOGICAL SEVERE ISCHEMIC EVENTS IN TAKAYASU’S ARTERITIS
Authors: L. Wang, Y. Sun, X. Dai, X. Kong, L. MA, X. Dai, L. MA, L. Jiang
Journal: Annals of the Rheumatic Diseases (2022)

Background Takayasu’s arteritis (TAK) is an idiopathic systemic vasculitis characterized by the involvement of the aorta and its major branches [1] . The supra-aortic arteries are often involved in TAK, with the reported prevalence ranging from 40% to 84% [2-3] . Importantly, patients with supra-aortic involvement carry a higher risk of neurological severe ischemic events (SIE) [4-5] . The common carotid artery (CCA) is the most affected artery and is more closely associated with neurologic symptoms than other supra-aortic arteries [6] . Ultrasonography (US) has been regarded as the most popular, user-friendly, and repeatable tool for the diagnosis and follow-up of CCA injuries. Objectives Our aim was to characterize TAK with supra-aortic involvement and determine the associations between clinical features, carotid US parameters, and neurological SIE. Methods Patients with supra-aortic involvement including brachiocephalic trunk, bilateral common carotid artery and internal carotid artery, and bilateral subclavian and vertebral artery and baseline carotid US examination were enrolled. Bilateral carotid diameter, intima-media thickness (IMT), and peak systolic velocity (PSV) were measured by US. Then, IMT/diameter ratio (IDR) was calculated. Risk factors associated with neurological SIE were analyzed by multivariate logistic regression. Results Totally, 295 patients were included, of whom 93 (31.5%) experienced neurological SIE, with common carotid artery involved (81.7%). Involved supra-aortic artery distribution ( p =0.04) and number ( p &lt;0.01) differed between neurologic and non-neurologic SIE subjects, showing higher prevalence of common carotid and vertebral artery involvement in cases with neurological SIE and 57.1% neurological SIE patients having more than four involved arteries. The left carotid IMT ( p =0.03) and IDR ( p &lt;0.01) differed between patients with and without neurological SIE. The left carotid IDR (cut-off value ≥0.55, odds ratio [OR] 4.46; 95% confidence interval [CI] 2.05-9.71; p &lt;0.01) and PSV (≤76 cm/s, OR 3.38; 95% CI 1.62-7.04; p &lt;0.01) and involved supra-aortic artery number (≥4, OR 3.16; 95% CI 1.54-6.47; p &lt;0.01) were independently associated with neurological SIE. Conclusion The left carotid IDR, PSV and involved supra-aortic artery number would perform as valuable markers for recognizing neurological SIE in TAK patients with supra-aortic lesions. References [1]Kerr GS, Hallahan CW, Giordano J, et al. Takayasu arteritis. Ann Intern Med 1994; 120: 919-29. [2]Cong XL, Dai SM, Feng X, et al. Takayasu’s arteritis: clinical features and outcomes of 125 patients in China. Clin Rheumatol 2010; 29: 973-81. [3]Mirouse A, Biard L, Comarmond C, et al. Overall survival and mortality risk factors in Takayasu’s arteritis: a multicenter study of 318 patients. J Autoimmun 2019; 96: 35-9. [4]Porter A, Youngstein T, Tombetti E, Mason JC. Biologic therapy in supra-aortic Takayasu arteritis can improve symptoms of cerebral ischaemia without surgical intervention. Rheumatology (Oxford) 2020; 59 Suppl 3: iii28-32. [5]Michailidou D, Rosenblum JS, Rimland CA, Marko J, Ahlman MA, Grayson PC. Clinical symptoms and associated vascular imaging findings in Takayasu’s arteritis compared to giant cell arteritis. Ann Rheum Dis 2020; 79: 262-7. [6]Schäfer VS, Jin L, Schmidt WA. Imaging for diagnosis, monitoring, and outcome prediction of large vessel vasculitides. Curr Rheumatol Rep 2020; 22: 76. Disclosure of Interests None declared